Read Candace's bio and previous columns
May 1, 2009
Rx for Health Care Reform:
A Public Health Care Plan Choice
With an international swine
flu crisis at hand, health care reform becomes even more critical. All
Americans, regardless of employment status, deserve access to health care
beyond an occasional hit-and-run visit to an overburdened hospital emergency
Possibly the best shot for
real reform is the public (government) health insurance option devised by
Jacob Hacker, a professor of political science at the University of
California at Berkeley. He is also co-director of the law school’s Center
for Health, Economic and Family Security.
Hacker argues for healthy
competition in U.S. health care, defining it as a rivalry between private
health insurance and a public option that results in better health care and
greater health security for all Americans. (Such a private-public
combination already exists in programs like Medicare.)
“People like choices,” Sen.
Chris Dodd, D-Conn., recently told a group of reporters at a Kaiser Family
Foundation meeting to discuss health care reform progress. “I want the
public option to create opportunities for people who otherwise wouldn’t fit
into a private plan.”
Hacker structures his
proposed public plan along what he calls the “three Rs” of workable
public-private competition. First R: Rules that are the same for both the
public and the private health insurance plans, all of which would be
available in a national insurance purchasing exchange similar to the one in
Massachusetts. Second R: Risk adjustments that protect any plan from being
competitively disadvantaged if it enrolls a less healthy group of people.
Third R: Regional pricing that enables private and public plans to compete
within regions on the same terms. This keeps the public plan from competing
on a national basis with private plans that are priced regionally, lower or
Hacker’s public plan would
be Medicare-like, building on that program’s administrative infrastructure
and basic coverage but with a separate risk pool and different arrangements
for payment and benefits. By this, he means the traditional portion of
Medicare that directly pays hospitals and doctors to provide care instead of
the government contracting with private plans to provide health insurance
(the unnecessarily costly Medicare Advantage boondoggle courtesy of the Bush
The public plan Hacker
envisions would be a “self-sustaining, standalone plan that does not draw on
public funds,” he explained to reporters. It also offers improvements over
Medicare as it exists at present. These include a better payment system, an
expanded payment advisory committee, a new stakeholder advisory group, and
automatic triggers for review of procedures or payments based on expanded
data collection and analysis.
Hacker emphasizes that the
public plan must have authority to bargain for reasonable rates as a means
to control costs over time, a goal that is key to the success of health care
reform. Consumer Watchdog, a California-based non-profit organization
favoring single-payer health care reform, points out that Massachusetts
health care costs have exceeded projections because reform in the Bay State
did not include effective cost-control measures.
Although cost control is
critical, Hacker also argues that health care providers should be fairly
represented when the public plan negotiates for prices, and that price
bargaining must not negatively impact patients’ access to health care or
shift costs to private insurers. He says that the evidence that Medicare
underpays providers is weaker than commonly believed, and that so far, there
is little substantiation for claims that Medicare bargaining has undermined
access or quality.
One of the most interesting
aspects of Hacker’s proposal plan is the idea of a “medical home,” an
upfront payment to physicians who agree to serve as care coordinators for
patients. Those who opt for the medical home approach might receive as an
incentive reduced cost-sharing, a broader set of benefits, or both.
Over time, a medical home
enables greater coordination of health care between multiple providers, a
real benefit to patients with chronic conditions who are treated by a
variety of medical specialists. The medical home can help prevent problems
such as conflicts between prescribed medications or duplicate treatments.
The medical home might go a
long way toward improving U.S. health care overall. A future column will
examine the medical home in action.
© 2009 North Star Writers Group. May not be republished without permission.
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